When Junko Takeshita, MD, PhD, MSc, began practicing dermatology in Philadelphia, she had limited experience caring for Black patients during her medical training in the Pacific Northwest. So when Dr. Takeshita prescribed a medicated shampoo to treat scalp psoriasis to a black patient, she assumed the woman would use the shampoo every day.
When her symptoms did not improve by her next visit, Takeshita asked if she had been using shampoo every day. The patient said no. The doctor asked why not. It was then that Takeshita, who is of Asian descent, learned for the first time that many black women wash their hair every few days to once a week. This is because shampooing frequently damages her naturally dry hair.
Mr. Takeshita realized that because he did not have experience with similar hair types, he initially offered a plan that did not suit the patient’s habits. They developed a modified treatment plan based on the patient’s hair care plan.
This illustrates one of the many subtle ways in which the medical care of black patients can be affected by a doctor’s race. A growing body of research aims to better understand how and why patient and physician race influences care. Studies have shown correlations such as reduced infant mortality, increased patient compliance with medical guidelines, increased patient satisfaction, and improved patient understanding of cancer risk. One recent study found that black residents had longer life expectancies in counties with higher proportions of black primary care physicians.
However, other studies have shown that the benefits of racial concordance (i.e., concordance between patient and physician race) are modest, and have shown that the benefits of racial concordance (i.e., concordance between patient and physician race) are modest, reducing the relationship between Black physicians and Black patients on measurable health outcomes. Few studies have attempted to make the connection.
“Would you say that?” [a Black patient] Would having a black doctor lead to better health outcomes? Yes, it can. Because there is evidence that Black physicians provide better care to Black patients,” says Dr. Carrie Sutton, scientific director of health equity research at the MedStar Health Institute in Maryland. Previously, as director of AAMC’s Health Equity Research Division, he oversaw an unpublished systematic literature review of his 3,000 studies on the effects of race on physicians and patients.
Here’s what some of the evidence shows and what the implications are for healthcare providers.
Doctor and patient perception
A common element in many of the studies is patients’ perceptions of their interactions with their physicians, reflected in measures of trust, satisfaction, and understanding. for example:
- The study, led by Takeshita, an assistant professor of dermatology and epidemiology at the Perelman School of Medicine at the University of Pennsylvania, looked at the ratings that more than 117,000 patients gave their doctors. press gainy survey Patient stories. Physicians who treated patients of the same race were far more likely to: get the highest score.Other research I found a similar link Between racial concordance and patient satisfaction.
- In a study by the National Human Genome Research Institute, volunteer patients underwent virtual reality visits with 3D animated doctors to assess their risk of developing lung cancer, and researchers changed the doctor’s racial appearance for each patient. Black patients who perceived themselves as having received advice from a Black doctor subsequently provided a more accurate summary of their lung cancer risk; researchers draw conclusions A patient’s racial perceptions can “influence the processing” of information from a doctor.
The impact goes beyond emotion. Several studies have found that Black patients are more likely to follow their doctor’s recommendations after visiting a Black doctor.
- In a study led by researchers at Stanford University School of Medicine, more than 1,300 black men in Oakland, California, were recruited to fill out a health questionnaire and then received free physician consultations and checkups. The men assigned to black doctors quite likely Tell your doctor about your specific health concerns and get tested for diabetes and cholesterol after your visit.
- A study from NYU Grossman School of Medicine and NYU Langone Health found that patients with high blood pressure and symptoms of cardiovascular disease were more likely to have: Adhere to medication guidelines When receiving treatment from a doctor of the same race (including black, Hispanic, or Asian).
Indeed, such findings can be influenced by many factors, including the patient’s health status, previous experience in healthcare, and various elements of the doctor-patient encounter (such as waiting time); The study tried to take these into account. And the impact of overt racism (individual and structural) on patient care is documented in: numerous studieswhich shows health care workers minimizing Black patients’ pain complaints and Black patients. Experiencing racism in the emergency department.
However, racial concordance research reveals how race subtly influences patient-physician communication and decision-making, regardless of the intentions of either party. Doctors and patients bring subconscious racial perceptions into their conversations.
“We all have prejudices,” Takeshita says. “Most people go there [a medical visit] I try not to be biased, but bias exists on both sides. ”
Another factor is the tendency for people to quickly connect with others who appear similar to themselves.
“Sharing a common characteristic with someone, whether it’s race or gender, fosters trust between patient and doctor and usually increases communication between the two,” George Mason University Information Systems and operations management professor Brad Greenwood. University of Virginia (GMU) studies the impact of racial matching on infant mortality.
These common characteristics can include not only physical appearance, but also life experiences, such as having a wealthy or poor upbringing, being from a particular region of the country, or having a similar family background.
“It’s also important to understand the lived experiences of individuals,” Sutton says. When doctors and patients come from different worlds, perhaps due to social, economic, and cultural differences, “they may not automatically bond because they lack common experiences.”
That inherent connection instantly fosters trust, comfort, and open communication between doctor and patient. For example, an Oakland study that provided black men with tests for certain health conditions found that men were “more likely to bring up other health issues when seen by a black doctor, and black doctors were more likely to bring up other health issues than black doctors It turns out that there is a high possibility of writing. ”
In their conclusion, they write, “better communication between Black subjects and Black physicians explains our results.”
“Each person will come in with their own experience and that will influence it.” [doctor–patient] Even before the relationship started,” says Takeshita.
Health effects
The health implications of improving these interactions are still unclear. Few studies have tracked clinical outcomes such as lower blood sugar levels.
Sutton said most of the evidence is “absent” about any “actual, direct link” to measurable health outcomes for black patients seen by black doctors.
One study showing such evidence is GMU. Infant mortality researchThe study looked at neonatal deaths among 1.8 million births in Florida hospitals from 1992 to 2015. For babies born to black mothers, the researchers found that the death rate was much higher if the doctor who delivered and cared for the newborn was white.
“When Black newborns are cared for by Black physicians, they suffer half the mortality rate compared to white infants,” the study found. However, receiving treatment from a black doctor does not completely eliminate the disparity, as “black infants are in poorer health no matter who treats them.”
Greenwood said these factors may include that black babies and their mothers suffer from certain health conditions more than white babies and their mothers. For example, black mothers in the United States have higher rates of preterm birth than white mothers, he said.
Dr. Greenwood emphasized that “we have to be careful about pathologising” Black babies, saying, “Black newborns can be medically more difficult to treat, and Black doctors should be careful about pathologising Black babies. “Having lived in the United States, they are more susceptible to potential health problems.” And community.
Another study showed that areas with more black doctors were associated with stronger health outcomes.a Examining county-level health data The findings of a study led by the Health Resources and Services Administration concluded that on average, every 10% increase in the proportion of black primary care physicians is associated with a 30.6-day increase in life expectancy for black people in that county. Ta. (The study did not examine which doctors treated which patients.)
One possible reason for this correlation is that residents of these counties had more choices of doctors from diverse backgrounds, including more Black doctors, said one of the researchers. said Michael Dill, director of workforce research at AAMC.
The study “adds to a growing body of evidence” about the value of diversifying the physician workforce, Dill said. Diversity “improves provider choice for everyone. If it improves health outcomes for Black people, that’s in everyone’s best interest.”
what it means
This points to one of the lessons learned from these studies. Increasing the number of Black doctors would expand options for all patients and give more Black patients the opportunity to work with doctors they can easily identify and connect with. According to the AAMC, only 5.7% of physicians in the United States are black. Medical schools and medical associations have been trying to increase that number for decades. slow progress.
Although diversity is an important long-term goal, researchers argue that it is a mistake to interpret the findings on racial concordance to mean that black patients should see only black doctors. ing.
According to Takeshita’s research on patient satisfaction, “the provision of medical care to minority patients should not be left solely to minority physicians.” “It is also essential to increase cultural mindfulness so that all physicians can care for diverse patient populations in an equitable manner.”
This requires special education in medical school and for practicing professionals to effectively communicate with patients of different races and cultures than their own and to recognize the impact of race on health. Takeshita says it is necessary to continue medical education. “We need to make sure all doctors feel comfortable with the people who come in front of them,” she says.
Sutton emphasizes that increasing physician diversity and helping all physicians work with people from different cultures are not mutually exclusive.
“I want to promote diversity in physicians, but I also want to promote everyone to be good physicians,” Sutton says. “It’s everyone’s job to ensure that care is provided in an equitable and anti-racist manner.”
